DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE GHC INSPECTION REPORT
Facility Information

THE MIDMO YOUNG MEN'S CHRISTIAN ASSOCIATION

002205536

(660) 882-8500

757 3RD ST
BOONVILLE
MO  65233-1670

THE MIDMO YOUNG MEN'S CHRISTIAN ASSOCIATION



 

ROACH, ABBY ELIZABETH

cyndir@bhymca.org

Incorporated

LAUREN R RAYWARNKE

5 YEARS - 15 YEARS

74

SCHOOL AGE GHC

 
Inspection Information

05/12/2026

3:00 PM

4:42 PM

UNANNOUNCED

COMPLIANCE MONITORING

2513100776


DocumentDocument-Date
DISASTER AND EMERGENCY PREPAREDNESS PLAN 03/14/2018
DIRECTOR'S QUALIFICATIONS 02/14/2018
LOCAL ZONING APPROVAL 02/23/2010
ARTICLES OF INCORPORATION 02/23/2010
JOB RESPONSIBILITIES 02/25/2010
DAILY SCHEDULE 04/24/2018
DIAGRAM/INDOOR 04/27/2018
DIAGRAM/OUTDOOR 04/27/2018
LOCAL FIRE DEPARTMENT NOTIFICATION 10/18/2018
APPLICATION 03/02/2020
STAFF SHEET 08/31/2020
CERTIFICATE OF GOOD STANDING 04/29/2021
CHILD CARE PRACTICES 04/12/2022
DISCIPLINE POLICIES 04/12/2022
LINES OF ADMINISTRATIVE AUTHORITY 04/12/2022
POLICIES 04/12/2022
SAMPLE WEEKLY MENU 05/02/2022
SAMPLE FORMS 05/02/2022
EQUIPMENT LIST 04/06/2026
ANNUAL DECLARATION 04/06/2026
LISTING OF CHILD CARE STAFF/HOUSEHOLD MEMBERS 04/06/2026




Inspection determined facility to be in compliance with licensing rules.
Compliance Licensing Rules
Open Violations: 3
NOTE
The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.
Attendance at Time of Inspection
Total Staff 7
Total Children 39
StaffChildClass AgeNote
3 0 NO CHILDREN IN ATTENDANCE Corey Price-Cook in the kitchen preparing snack with 0 children, Director Cynthia Roth with 0 children in the main office. Site Director Abby Roach in the main office with 0 children.
2 17 SCHOOL AGE Caregivers Ethan Williams and Katie Pefferman with 17 children ages 8 through 12 year's old.
1 10 SCHOOL AGE Caregiver Mackenzie Kemp with 10 children ages 5 through 7 year's old.
1 12 SCHOOL AGE Caregiver Sarah Searles with 12 childen ages 7 through 8 year's old.

Compliance List
5 CSR 25-500.032 Organization and Administration
Compliance
5 CSR 25-500.042 Licensing Process
Compliance
5 CSR 25-500.052 Annual Requirements
Compliance
5 CSR 25-500.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Compliance
5 CSR 25-500.090 Disaster and Emergency Preparedness
Violation
 Provider Comments
Violation
Requirements of the facility's participation in disaster and emergency drills were not met as evidenced by the disaster or emergency drill was not held at least one time every three months.
Licensing Rule Reference
5 CSR 25-500.090 Disaster and Emergency Preparedness (3) (A) states: The licensee shall ensure that the facility has on file documentation that, at least every three (3) months, all staff and children at the facility have participated in a disaster or emergency drill based on the facility's disaster and emergency plan.
Correction Required
Fire, tornado, and other disaster drills shall be completed and recorded as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.092 Furniture, Equipment and Materials
Compliance
5 CSR 25-500.102 Personnel
Compliance
5 CSR 25-500.112 Staff/Child Ratios
Compliance
5 CSR 25-500.122 Medical Examination Reports
Violation
 Provider Comments
Violation
Medical examination report was not on file for Katie Pfefferman as evidenced by a medical examination was not on file within 30 days of an individual beginning to work with children.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (A) states: All persons working in a child care facility in any capacity during child care hours, including volunteers counted in staff/child ratios, shall be in good physical and emotional health with no physical or mental conditions which would interfere with child care responsibilities. These persons shall have a medical examination report, signed by a licensed physician or registered nurse who is under the supervision of a licensed physician, on file at the facility at the time of initial licensure or within thirty (30) days following employment.
Correction Required
Medical reports shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
A medical examination report did not include either a completed Risk Assessment for Tuberculosis form or a negative tuberculin skin test (TST) within 12 months of the individual's begin date at the facility for the following staff: Katie Pfefferman.
Licensing Rule Reference
5 CSR 25-500.122 Medical Examination Reports (1) (B) . states: Medical examination reports shall include either a Tuberculosis (TB) Risk Assessment form, completed and signed by a health care professional, or a negative tuberculin skin test (TST) completed not more than twelve (12) months before beginning work in the facility. The Tuberculosis (TB) Risk Assessment form, revised March 2014, is incorporated by reference in this rule, as published by the Missouri Department of Health and Senior Services, PO Box 570, Jefferson City, MO 65102 and available by the Missouri Department of Health and Senior Services at https://health.mo.gov/living/healthcondiseases/communicable/tuberculosis/tbmanual/pdf/RiskAssessmentform.pdf. If the person has signs or symptoms of tuberculosis, or risk factors for tuberculosis, then testing for tuberculosis shall occur.
Correction Required
Medical examination reports shall include Risk Assessment for Tuberculosis forms or negative tuberulin skin test (TST) as required.

Correction Verification
Submit Documentation

Compliance Date

5 CSR 25-500.132 Admission Policies and Procedures
Violation
 Provider Comments
Violation
The facility did not meet requirements for child enrollment and health information as evidenced by 1 child did not have The MidMo Young Men's Christian Association indicated on the enrollment form as authorized for emergency medical care.
Licensing Rule Reference
5 CSR 25-500.132 Admission Policies and Procedures (8) (E) 4. states: Instructions for action to be taken if the parent(s) or physician designated by the parent(s) cannot be reached in an emergency and permission for emergency medical care;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
5/12/2026
5 CSR 25-500.142 Nighttime Care
Compliance
5 CSR 25-500.162 Overlap Care of Children
Compliance
5 CSR 25-500.162 Overlap Care of Children
Compliance
5 CSR 25-500.172 Emergency School Closings
Compliance
5 CSR 25-500.182 Child Care Program
Compliance
5 CSR 25-500.192 Health Care
Compliance
5 CSR 25-500.202 Nutrition and Food Service
Compliance
5 CSR 25-500.212 Transportation and Field Trips
Compliance
5 CSR 25-500.222 Records and Reports
Violation
 Provider Comments
Violation
2 child(ren) records did not include employers' address of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
5/12/2026
Violation
4 child(ren) records did not include work telephone number of parent(s), guardian or legal custodian.
Licensing Rule Reference
5 CSR 25-500.222 Records and Reports (2) (B) states: Full name of the parent(s), guardian or legal custodian, home address, employers' name and address, work schedule, and home and work telephone numbers;
Correction Required
Child enrollment information shall be completed and on file as required.

Correction Verification
Corrected on Site

Compliance Date
5/12/2026
5 CSR 25-600.020 General Requirements
Compliance
5 CSR 25-600.040 Background Screening Findings
Compliance
RSMo 210.115. Reports of abuse, neglect, and under age eighteen deaths — persons required to report — supervisors and administrators not to impede reporting — deaths required to be reported to the division or child fatality review panel, when — report made to another state, when. —
Compliance
RSMo 210.211.  License required - exceptions - written notice of licensure status, when.
Compliance